Provider Demographics
NPI:1700513264
Name:COWDEN MENTORING GROUP
Entity type:Organization
Organization Name:COWDEN MENTORING GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BEHAVIORAL HEALTH PROVIDER
Authorized Official - Prefix:MR
Authorized Official - First Name:KERRY
Authorized Official - Middle Name:V
Authorized Official - Last Name:COWDEN
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:317-488-1417
Mailing Address - Street 1:5868 E 71ST ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46220-4075
Mailing Address - Country:US
Mailing Address - Phone:317-488-1417
Mailing Address - Fax:
Practice Address - Street 1:12510 BENT OAK LN
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46236-7378
Practice Address - Country:US
Practice Address - Phone:317-488-1417
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-04
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty